Surgical and other medical operations are often performed at sites deep within a patient's body. In the past, the only way to perform such medical procedures was to cut a large enough incision in the patient's body to expose the operating site sufficiently to permit direct access by a physician. However, such operations typically caused a great deal of trauma to the affected tissue requiring lengthy periods for recovery and causing the patient substantial pain and suffering. With technological advances in the medical profession, more and more of these medical operations are being performed using less invasive endoscopic (e.g., arthroscopic and laproscopic procedures) and similar procedures. In general, endoscopic procedures include using an instrument having a delivery tube with an inner bore through which a tool can be inserted. Depending on the medical procedure, the delivery tube can have a variety of shapes (e.g., straight, curved, etc. . . . ) and be either rigid or flexible. With such an instrument, the delivery tube is usually inserted into the patient's body by way of either a comparatively small incision or a body orifice and through a body cavity or hollow organ to the site desired. In this way, any trauma to the patient's body can be generally limited to surrounding tissue along the insertion path of the delivery tube. One such endoscopic instrument incorporates a fiber optic system. Image transmission by optical fibers is widely used in medical instruments for viewing inside the human body and in a variety of other applications. Such instruments have been used for diagnostic purposes and to observe during operating procedures. Optical fibers have also been developed to carry high-power laser beams for cauterizing, cutting and drilling. With such instruments, a lens affixed to an optical fiber is inserted through the rigid delivery tube to the desired site inside the patient's body. However, once delivered to the site, the lens is typically difficult to maneuver and manipulate in order to view the site in its entirety, or adequately laser cauterize, cut or drill at the site. This is especially true when the operating site is deep in the patient's body, far from the point of entry of the instrument into the body or at the end of a curved or otherwise tortuous path through the body.
Because of the difficulties encountered in maneuvering and manipulating such fiber optic instruments, some medical procedures must still be preformed without the aid of such instruments. For example, a number of periodontal procedures are preformed with the surgeon having to rely solely on his/her sense of touch. Periodontology includes the treatments of patients having diseased gums which have separated from around the root of a patient's tooth. It is sometimes necessary to remove diseased tissue from the inside surface of the patient's gum around the affected tooth and to remove calculus from the tooth root surface. Having to rely solely on the sense of touch did not always ensure that the procedure would be preformed thoroughly (i.e., that all the diseased tissue or calculus would be removed). If the physician needed to observe around the tooth root during either procedure, an incision would typically have to be made through the gum tissue in order to open up the area for viewing. As another example, the existing root of a patient's tooth is often used as an anchor for a prosthetic tooth or crown. In such a procedure, the root canal should be thoroughly sterilized and filled with a suitable filler to prevent the subsequent intrusion of bacteria and decay of the root. However, with prior instruments, it is not always possible to ensure that the root canal has been completely sterilized and filled.
Even when a conventional fiber optic instrument can be used to observe an operating procedure (e.g., an arthroscopic ligament repair), it is often necessary to tilt the delivery tube at various angles in order to properly observe the entire procedure. Such manipulation of the delivery tube typically causes stretching of and additional trauma to the surrounding tissue, resulting in longer recovery periods and in some cases additional discomfort and pain for the patient. In addition, during such procedures other endoscopic delivery tubes are typically inserted through separate incisions in the patient's body to gain simultaneous access to the operating site. This permits multiple tools to be used at one time. The more incisions made, however, the more trauma to the surrounding tissue, the more pain and suffering likely to be endured by the patient and again the longer the recovery period. For some operating sites, such as at the end of or along a narrow cavity or hollow organ, space constraints only allow one delivery tube to be used at a time. In such a situation, some operations cannot be simultaneously observed while they are being performed. Therefore, there is also a need for a multiple function instrument which permits more than one tool to be used at the same time through a single incision, cavity or hollow organ.
Similar endoscopic-type instruments have also been used to perform visual inspections deep within objects, such as a bore or other cavity in a mechanical component or machine. However, the ability of such instruments to inspect a site at various angles is typically limited due to the lack of maneuverability of such instruments. Such limitations can require the object to be dismantled in order to perform an adequate inspection, thereby increasing the cost of inspection. In addition, if it cannot be dismantled, the object may have to remain uninspected, thereby increasing the risk of an undetected defect.
During some endoscopic procedures, it may become necessary to suture tissue. Currently, endoscopic-type suturing instruments have been developed to suture tissue located in a patient's body without having to make a major incision to gain direct access to the suture site. For example, long and narrow forceps have been developed for gripping a conventional curved surgical needle and enabling tissue to be sutured deep in a patient's body. Such a suturing instrument is less invasive than cutting a large enough incision to permit direct access by the physician. However, the uses for such suturing instruments are still limited due to the size of the instrument, in particular its diameter, and the shape of the needle being held. A number of areas in the patient's body cannot be reached except through pathways (i.e., cavities, hollow organs, etc. . . . ) that are far to narrow to receive conventional forceps type suturing instruments. In addition, another incision or entry site into the body is often necessary in order to view the procedure. Thus, there is a need for an even less invasive suturing instrument, and one that permits the suturing of tissue in even harder to reach locations in the patient's body than heretofore possible with such a prior conventional endoscopic-type suturing instrument.
Another endoscopic instrument employs a solid superelastic wire which is made to curve when it exists the delivery tube in order to encircle and thereby aid in locating cancerous tumors. One such wire locator instrument, commonly referred to by the trademark Homer Mammalock, is used to help locate cancerous tumors in a woman's breast. Because such tumors are typically denser than the surrounding fatty tissue, the locator wire tends to encircle rather than pass through the tumor. Being surrounded by the locator wire, the tumor is easier to locate using external imaging systems, like conventional x-rays. Even though such wire locator instruments have had some success, there is still a need to improve the ability of such instruments to locate tumors.